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Large amounts of waste in hospitals are generated in the operating rooms from disposable surgical supplies. Tonsillectomy/adenotonsillectomy (T&A) cases use many disposable supplies that are not recyclable. It is critical to reduce disposable waste, as such waste directly affects the environment and increases health care costs. The authors noticed a difference between the number of disposable items prepared, available, but almost never used, for each tonsillectomy case between a children's hospital setting and a university ambulatory surgery center setting. The aims were the following: (1) identify what disposable medical supplies were unnecessarily opened for each case, (2) eliminate all disposable medical waste that was not critical to the case in both settings, and (3) determine the cost reduction at both hospital and surgery center facilities by revising the current disposable instruments/supplies pulled for tonsillectomy cases. The authors report projected cost savings and reduction in waste for one children's hospital and nationally based on their waste reduction.